Is “Itinerant” or “In House” Oral Surgery a Good Idea?

We live in a world of ever changing status updates, picture posts, on-demand viewing, and real-time news awareness.  We want services fast, efficient, and as soon as possible.  Interestingly, a recent trend in oral surgery reflects the “get it now” nature of our sound byte society.

Is “In Itinerant Oral Surgery” a Good Idea?

Some patients are being asked to utilize the “in-house” oral surgeon who works out of the general dentist’s office but typically only visits the dental office once or twice a month.  Often, consultation and treatment recommendations are discussed by the general dentist, then the patient returns when the traveling, or in-house, oral surgeon is available.

Pros of “Itinerant Oral Surgery”

• Advocates of the “in-house” or “under one roof” surgery care say they provide patients with a familiar office environment for surgery.

Cons of “Itinerant Oral Surgery”

• The in-house oral surgeon travels to multiple offices and may have limited ability to return to your dentist’s office or your community when needed.
• Most dental offices are not set up for emergencies. Oral surgeons with established practices spend their careers focusing on patient safety, and their offices are structured for this purpose.
• Most dental staff are not trained for surgical emergencies. Oral surgeons with established practices have trained staff who are well versed in office emergencies.  Staff familiarity with their office set-up is critical should an office emergency arise.
• Some patients find it discomforting to discuss the treatment options and alternatives with someone other than the actual surgeon performing the procedure.
• Some patients feel rushed the day of surgery when they meet their doctor a few minutes prior to surgery.
• General practitioner offices that utilize traveling oral surgeons do not undergo (OAE) certifications. Oral surgeons who administer office-based anesthesia are required to have an Office Anesthesia Evaluation (OAE) that insures their facility meets the standards of the profession and the state to provide safe and effective anesthesia.
• Management of complications can be another potential frustration for patients who have surgery with a traveling oral surgeon.  When will that oral surgeon return?  Will you have to travel to one of their other offices to be seen?  Is the surgeon delegating post-op management to the dentist?  Who will maintain your patient records?  Will other providers or doctors be able to easily contact your surgeon if that surgeon doesn’t have an established office?

The AAOMS and the ADA Discourage Itinerant Oral Surgery.

The American Association of Oral and Maxillofacial Surgeons (AAOMS), the governing board for oral surgeons, and the American Dental Association (ADA) have weighed in on these pros and cons.  The AAOMS Code of Professional Conduct discourages its members from participating in itinerant surgery.  The authors advise against delegating post-surgery management to people without equal specialty qualifications (i.e. your general dentist).  They further warn against performing anesthesia and surgery in offices that are not primarily set up or equipped for such purposes (Code of Professional Conduct, aaoms.org).  The ADA Code of Ethics has sections on patient abandonment, consultation, and referral that apply to complications from traveling oral surgeons and were highlighted in a previous article in their national publication (Senseny, JADA 2013).

What does this mean for you if you are needing or considering oral surgery care recommended by your dentist?

The following questions can help you decide where you should have oral surgery that prioritizes YOUR best interests and safety.

1. Would surgery be safer in a surgical office, designed and equipped to provide anesthesia on a daily basis?
2. Will the traveling oral surgeon have a staff that cares for surgical patients under sedation on a daily basis or will the dentist’s staff be used?
3. Has the office where I am having my anesthesia had an office anesthesia evaluation, ensuring the office meets the state standards?
4. Can I discuss in detail my treatment with the surgeon before the day of surgery?
5. Who will handle my questions after surgery, and how available is the traveling oral surgeon if I need to be seen?
6. If there is an oral surgeon in my community who is available, what is the need to wait several weeks until the “in house” oral surgeon comes to the dental office?
7. Do the oral surgeon and dentist share the fees for my procedure, and has this influenced the recommendation to use the “in house” oral surgeon?
8. Does the dental office staff have experience in working with both medical and dental insurance plans to minimize your surgery expenses?